Influence of isolated low-grade intracranial haemorrhages on the neurodevelopmental outcome of infants born very low birthweight

Sara Uccella; Alessandro Parodi; Maria Grazia Calevo; Lino Nobili; Domenico Tortora; Mariasavina Severino; Chiara Andreato; Eu-Brain Neonatal Group; Andrea Rossi; Luca Antonio Ramenghi

doi:10.1111/dmcn.15559

Influence of isolated low-grade intracranial haemorrhages on the neurodevelopmental outcome of infants born very low birthweight

Dev Med Child Neurol. 2023 Mar 30. doi: 10.1111/dmcn.15559. Online ahead of print.

Authors

Sara Uccella^{1

2

3}, Alessandro Parodi³, Maria Grazia Calevo⁴, Lino Nobili^{1

2}, Domenico Tortora⁵, Mariasavina Severino⁵, Chiara Andreato^{1

3}; Eu-Brain Neonatal Group; Andrea Rossi⁵, Luca Antonio Ramenghi^{1

3}

Collaborators

Eu-Brain Neonatal Group:
Deborah Preiti, Cristina Traggiai, Paolo Massirio, Agata Zoia, Paul Govaert, Diego Minghetti, Chiara Tacchino, Giorgia Brigati, Paolo Moretti, Elisa De Grandis, Laura Siri, Samuele Caruggi, Battaglini Marcella, Mariya Malova

Affiliations

¹ Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
² Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
³ Neonatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
⁴ Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
⁵ Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.

PMID: 36998157
DOI: 10.1111/dmcn.15559

Abstract

Aim: To determine whether isolated low-grade germinal matrix-intraventricular haemorrhages (LG-GMH-IVH) and low-grade punctate cerebellar haemorrhages (LG-CBH) contribute to the neurodevelopment of infants born preterm with very low birthweight (VLBW).

Method: A prospective observational cohort study was conducted on infants born with VLBW hospitalized from January 2012 to July 2017 who had undergone serial cranial ultrasounds since birth and magnetic resonance susceptibility-weighted imaging of the brain at term-corrected age. Only those with VLBW carrying isolated LG-GMH-IVH (grades 1 or 2) or isolated LG-CBH (punctate cerebellar haemorrhages ≤4 mm in diameter) or absence of lesions (no-lesion) were enrolled and followed up to 3 years. The Griffiths Mental Development Scales, Extended and Revised version (GMDS-ER), were used to assess neurodevelopment, considering unsatisfactory scores less than 85. Behaviour, according to the criteria of the International Classification of Diseases, 10th Revision, and rehabilitation data were noted.

Results: Two-hundred and forty infants with VLBW were enrolled: 34 with LG-GMH-IVH, 17 with LG-CBH, and 189 as no-lesion. The LG-GMH-IVH and LG-CBH groups scored worse than the no-lesion group on all GMDS-ER scores for 1 year, 2 years, and 3 years. The LG-CBH group scored lower than the LG-GMH-IVH group for total GMDS-ER scores at 1 year and 2 years but not at 3 years. At 3 years, compared with the LG-CBH group, those with LG-GMH-IVH received less and later physical therapy, with more frequent attention problems. The odds ratio for unsatisfactory GMDS-ER scores corrected for gestational age was 5.75 for LG-CBH (95% confidence interval 1.92-17.25; p = 0.002) and 2.67 for LG-GMH-IVH (95% confidence interval 1.16-6.13; p = 0.02).

Interpretation: Low-grade haemorrhages affect the neurodevelopment of very-low-birthweight infants. Early rehabilitation might have contributed to their development.